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COPYRIGHT 2004 All rights reserved. Reproduced by permission of The Condé Nast Publications Inc.
Soon after the collapse of the World Trade Center, experts predicted that one out of five New Yorkers--some one and a half million people--would be traumatized by the tragedy and require psychological care. Within weeks, several thousand grief and crisis counsellors arrived in the city. Some were dispatched by charitable and religious organizations; many others worked for private companies that provide services to businesses following catastrophes.
In the United States, grief and crisis counsellors generally use a method called critical-incident stress debriefing, which was created, in 1974, by Jeffrey T. Mitchell, a Maryland paramedic who was studying for a master's degree in psychology. Mitchell had seen a gruesome accident while on the job: a young bride, still in her wedding dress, had been impaled when the car that her drunk husband was driving rear-ended a pickup truck loaded with pipes. He was unable to shake the memory. Six months later, he confided his troubles to a friend--a firefighter who had witnessed similar horrors. The friend asked him to describe exactly what he had seen. Mitchell felt greatly relieved by this conversation, and became convinced that he had stumbled across an invaluable therapeutic approach. Indeed, he came to think that if a "debriefing" conversation was held soon after an upsetting event it could help prevent the onset of post-traumatic stress disorder.
In 1983, Mitchell received a Ph.D. in human development, and he began crafting a structured seven-step debriefing regimen that could be applied to groups of paramedics, firefighters, and other professionals who regularly witnessed traumatic events. Six years later, he started a nonprofit organization, the International Critical Incident Stress Foundation, to teach debriefing and related methods. The foundation has grown steadily, and more than thirty thousand counsellors are trained by it each year.
In a typical debriefing session, crisis counsellors introduce themselves and provide basic information about common stress reactions--sleeplessness, headache, irritability--as well as more debilitating symptoms, like flashbacks and delusions. Each participant is then asked to identify himself, pinpoint where he was during the tragic event (or "critical incident"), and describe what he witnessed. This is known as the "fact phase." The discussion next turns in a more emotional direction, as each participant is asked to divulge what he was thinking during the event. The purpose of sharing such memories is, in part, to draw out group members who "bottle up" their emotions. At the end of this process, the conversation enters the "feeling phase," focussing on each participant's current reaction to the catastrophe. (The counsellors ask questions like "What was the worst part of the incident for you personally?") Finally, the counsellors discuss strategies for coping with stress and suggest services that can provide additional help; by the end of the session, participants are considered ready for "reentry" into the world. The group does not meet for a follow-up session.
I recently spoke with a man who worked at a travel agency on Liberty Street, across from where the Twin Towers once stood. He had been in the subway when the towers collapsed, but after considerable difficulty he made it home safely. "I was called by the company the next day and told to report to headquarters on Thursday," he told me. His parent corporation, which was situated in midtown, and had numerous offices throughout the city, had hired an organization called National Employee Assistance Providers to give debriefing sessions. Many of its counsellors used texts created by Mitchell's foundation during their training.
Most debriefings occur between twelve and seventy-two hours after a catastrophe, according to "Blindsided: A Manager's Guide to Catastrophic Incidents in the Workplace," by Bruce T. Blythe, the C.E.O. of Crisis Management International, a company...
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